自体外周血干细胞移植治疗下肢动脉硬化性闭塞症  

Transplantation of autologous peripheral blood stem cells for the treatment of lower limb arteriosclerosis obliterans

作　　者：黄平平[1] 李尚珠[1] 韩明哲[1] 肖志坚[1] 杨仁池[1] 邱录贵[1] 钱冠清[1] 付仁敏[1] 郑亚丽[1] 刘春华[1] 徐秀强[1] 李君凡[1] 韩忠朝[1] 

机构地区：[1]中国医学科学院中国协和医科大学血液学研究所,血液病医院,国家干细胞工程技术研究中心,天津300020

出　　处：《中华血液学杂志》2003年第6期308-311,共4页Chinese Journal of Hematology

基　　金：国家攀登计划资助 ( 95-专- 10 );国家 863计划资助( 2 0 0 1AA2 15 3 11;2 0 0 2AA2 2 3 3 5 4)

摘　　要：目的　评价动员后自体外周血干细胞移植治疗下肢动脉硬化性闭塞症 (ASO)的临床疗效及部分影响因素。方法　确诊严重ASO患者 1例 ,予rhG CSF 30 0 μg皮下注射 ,每日 2次 ,进行外周血干细胞动员 ,第 5天用血细胞分离机单采干细胞 ,配成干细胞混悬液。将干细胞混悬液肌肉注射进行双下肢移植 (3× 10 9细胞 肢 )。 4 4d后给病情较重的左下肢第 2次移植相同的细胞数。观察 3个月 ,进行各项指标综合评估。结果　外周血干细胞移植后 ,患者疼痛、患肢冷感、间歇性跛行、溃疡明显好转 ,左右足踝压指数 (ABI)分别由 0 .4 9,0 .6 9升为 0 .5 0 ,0 .85。移植后 1个月末梢血流波幅 [(11.90± 10 .95 )mm]和激光多谱勒扫描血流灌注量 [(0 .4 9± 0 .16 )PU]较移植前 [分别为 (1.70± 1.95 )mm ,(0 2 7± 0 .0 8)PU]显著改善 (P <0 .0 1)。数字减影下肢动脉造影结果显示新侧支血管形成明显增加 (评分结果为 3)。未出现并发症和不良反应。结论　采用动员后的外周血干细胞移植治疗ASO患者 ,方法简单、安全、有效 ,值得推广应用和深入研究。Objective To evaluate the clinical efficacy of mobilized autologous peripheral blood stem cells (PBSC) transplantation in a 48 years old patient with lower limb arteriosclerosis obliterans (ASO). Methods rhG-CSF 600 μg/d for 5 days to mobilize stem cells. On the fifth day, PBSC were collected with a Version 4 blood-cells separator. Three hours late, the PBSC were intramuscularly injected into the ischemic areas of the two lower limbs (3×10 9 cells per limb). The clinical and laboratory findings were monitored every week for 3 months. Forty-four days after the implantation, left lower limb with severe ASO was given an additional implantation of the same number of cells as the first time. Results The peripheral blood CD 34+ cells were increased from 0.18% to 0.75% after 5 days of rhG-CSF mobilization. Three months after the first stem cell transplantation, severe pain lameness, local cool-feeling and ulcer were improved, and ABI increased from 0.49,0.69 to 0.50,0.85, the amplitude of blood flow and laser Doppler blood perfusion were also significantly improved(P<0.01). At the same time, digital subtraction angiographic scores for new collateral vessel formation were showed as +3(rich). No related complication or adverse effect were observed during the 3-month observation. Conclusion Transplantation of mobilized autologous PBSC might be a simple, safe, and effective method for the treatment of ASO.

关 键 词：自体外周血干细胞移植 治疗 下肢动脉硬化性闭塞症 疗效观察 

分 类 号：R543.5[医药卫生—心血管疾病] R457.7[医药卫生—内科学]